Chronic Disease Management Articles/Papers/Research
1. Kaiser Permanente
Hospital bed utilisation in the NHS, Kaiser Permanente, and the US Medicare programme: analysis of routine data. Ham C, York N, Sutch S, Shaw R. BMJ [Clinical Research Ed.] [NLM - MEDLINE]. Nov 29 2003. Vol. 327, Iss. 7426; p. 1257
Full Text BMJ Website Link (Including Links To Responses And Letters To This Article)
Reforming Health Systems: Learning from Managed Care Models. Presentation by Chris Ham, Director, Department of Health Strategy Unit. Compares Kaiser Permanente to NHS. Based on BMJ article above:
Objective To compare the utilisation of hospital beds in the NHS in England, Kaiser Permanente in California, and the Medicare programme in the United States and California. Design Analysis of routinely available data from 2000 and 2001 on inpatient admissions, lengths of stay, and bed days in populations aged over 65 for 11 leading causes of use of acute beds.
Setting Comparison of NHS data with data from Kaiser Permanente in California and the Medicare programme in California and the United States; interviews with Kaiser Permanente staff and visits to Kaiser facilities. Results Bed day use in the NHS for the 11 leading causes is three and a half times that of Kaiser’s standardised rate, almost twice that of the Medicare California’s standardised rate, and more than 50% higher than the standardised rate in Medicare in the United States. Kaiser achieves these results through a combination of low admission rates and relatively short stays. The lower use of bed days in Medicare in California compared with Medicare in the United States suggests there is a “California effect” as well as a “Kaiser effect” in hospital utilisation.
Conclusion The NHS can learn from Kaiser’s integrated approach, the focus on chronic diseases and their effective management, the emphasis placed on self care, the role of intermediate care, and the leadership provided by doctors in Throughout the paper we use the term Kaiser as shorthand for the Kaiser Permanente Medical Care Programme. The programme is made up of the Kaiser Foundation Health Plan, Kaiser Foundation Hospitals, and the Permanente Medical Groups. There are more than 10 000 Permanente physicians in the medical groups and they serve more than 8 million Kaiser Permanente members. Kaiser is one of the oldest established health plans in the United States; it uses a range of managed care techniques (see below) to ensure that resources are used efficiently.
Getting more for their dollar: a comparison of the NHS with California's Kaiser Permanente. Feachem RG, Sekhri NK, White KL. BMJ [Clinical Research Ed.] [NLM - MEDLINE]. Jan 19 2002. Vol. 324, Iss. 7330; p. 135
Objective To compare the costs and performance of the NHS with those of an integrated system for financing and delivery health services (Kaiser Permanente) in California.
Methods The adjusted costs of the two systems and their performance were compared with respect to inputs, use, access to services, responsiveness, and limited quality indicators.
Results The per capita costs of the two systems, adjusted for differences in benefits, special activities, population characteristics, and the cost environment, were similar to within 10%. Some aspects of performance differed. In particular, Kaiser members experience more comprehensive and convenient primary care services and much more rapid access to specialist services and hospital admissions. Age adjusted rates of use of acute hospital services in Kaiser were one third of those in the NHS.
Conclusions The widely held beliefs that the NHS is efficient and that poor performance in certain areas is largely explained by under investment are not supported by this analysis. Kaiser achieved better performance at roughly the same cost as the NHS because of integration throughout the system, efficient management of hospital use, the benefits of competition, and greater investment in information technology.
National Primary and Care Trust Development Programme
Learning from Kaiser Permanente - A Briefing for PEC Members
The basics on Kaiser Permanente put together following BMJ articles.
2. Evercare
Implementing the Evercare Programme - Interim Report (Feb 2004)
Report by Evercare on the implement the Evercare model of care management at 9 NHS PCTs.
In autumn 2002, the Department of Health in England invited Ovation’s Evercare programme to contribute its tools, techniques, and expertise to help Primary Care Trusts (PCTs) enhance the speed and certainty of achieving the NHS Plan. An eight-week assessment in 10 PCTs was completed in February 2003. Following this, nine PCTs elected to implement the Evercare model of care management to improve the health of frail older people whilst reducing their need for hospitalisations.
This interim report provides a midterm review of the 17-month implementation phase of the Evercare project. The implementation phase began in April 2003 and runs through August 2004.
Evaluation of the Evercare Demonstration Program Final Report. Robert L. Kane, MD, Principal Investigator; Gail Keckhafer, Coordinator; John Robst, Federal Project Officer: Division of Health Service Research and Policy, School of Public Health, University of Minnesota.
Evercare represents a new approach to providing medical services to long-stay nursing home patients. It offers a capitated package of Medicare-covered services with more intensive primary care provided by nurse practitioners (NPs) to supplement, not supplant, the medical care provided by physicians. The program’s underlying premise holds that better primary care will result in reduced hospital use. At the same time, Evercare strives to optimize the health and wellbeing of the nursing home resident by providing complete, customized care planning, care coordination, and care delivery for frail and chronically ill elderly people living in nursing homes.
Conclusion. The Evercare program meets its objectives of reducing hospital admissions while providing quality and coordinated care to the nursing home resident. While the number of hospitalizations were reduced, indications of quality and patient satisfaction showed Evercare enrollees to receive care at least equal to that received by the control in both Evercare homes and homes not affiliated with Evercare. As the Evercare program continues to mature, it offers promise for continued reduction in unnecessary hospitalization. The use of Intensive Service Days provides an opportunity for residents to be treated in the nursing home without the disruption of travel to a hospital for a large segment of illness events.
The Effect of Evercare on Hospital Use. Kane RL, Keckhafer G, Bershadsky B, Siadaty MS. Journal of the American Geriatrics Society Volume 51, Issue 10, Page 1427-1434, Oct 2003
OBJECTIVES To examine the use of hospital and related medical care services of a novel managed care program using nurse practitioners (NPs) and directed specifically at long-stay nursing home residents. DESIGN Quasi-experimental post-test design with two control groups to minimize selection bias. SETTING Nursing homes. PARTICIPANTS Evercare enrollees in five sites were compared with two sets of controls: nursing home residents in the same nursing homes who did not enroll in Evercare (control-in) and residents of nursing homes that did not participate in Evercare (control-out). MEASUREMENTS Utilization data from Medicare and United Healthcare (the parent corporation for Evercare) were obtained for slightly more than 2 years. Patterns of use were assessed by calculating the monthly use rate for each group and aggregating to form annual rates. Usages addressed included hospital admissions and days, emergency room visits, therapy services, mental health services, and podiatry. Adjustments were made to correct for age, race, and sex. Because the groups differed in terms of the rate of cognitive impairment, the analysis was stratified on this variable. RESULTS The incidence of hospitalizations was twice as high in control residents as in Evercare residents (4.63 and 4.67 per 100 enrollees per month vs 2.43 in the 15 months after census, P<.001). This difference corresponded to Evercare's use of intensive service days. The same pattern held for preventable hospitalizations (0.80 and 0.86 vs 0.28, P<.001). The pattern held when residents were stratified by cognitive status. On average, using a NP is estimated to save about $103,000 a year in hospital costs per NP. CONCLUSION The use of active primary care provided by NPs may have prevented the occurrence of some hospitalizable events, but its major effect was allowing cases to be managed more cost-effectively.
3. Veterans
Effect of the transformation of the veterans affairs health care system on the quality of care. Ashish K Jha, Jonathan B Perlin, Kenneth W Kizer, R Adams Dudley. The New England Journal of Medicine. Boston: May 29, 2003. Vol. 348, Iss. 22; p. 2218 (10 pages)
BACKGROUND: In the mid-1990s, the Department of Veterans Affairs (VA) health care system initiated a systemwide reengineering to, among other things, improve its quality of care. We sought to determine the subsequent change in the quality of health care and to compare the quality with that of the Medicare fee-for-service program. METHODS: Using data from an ongoing performance-evaluation program in the VA, we evaluated the quality of preventive, acute, and chronic care. We assessed the change in quality-of-care indicators from 1994 (before reengineering) through 2000 and compared the quality of care with that afforded by the Medicare fee-for-service system, using the same indicators of quality. RESULTS: In fiscal year 2000, throughout the VA system, the percentage of patients receiving appropriate care was 90 percent or greater for 9 of 17 quality-of-care indicators and exceeded 70 percent for 13 of 17 indicators. There were statistically significant improvements in quality from 1994-1995 through 2000 for all nine indicators that were collected in all years. As compared with the Medicare fee-for-service program, the VA performed significantly better on all 11 similar quality indicators for the period from 1997 through 1999. In 2000, the VA outperformed Medicare on 12 of 13 indicators. CONCLUSIONS: The quality of care in the VA health care system substantially improved after the implementation of a systemwide reengineering and, during the period from 1997 through 2000, was significantly better than that in the Medicare fee-for-service program. These data suggest that the quality-improvement initiatives adopted by the VA in the mid-1990s were effective.
4. New South Wales
NSW Chronic and Complex Care Programs: Progress Report For Program activity to 30 September 2002
The NSW Government Action Plan for Health Chronic and Complex Care Priority Health Care programs are now in their second year of operation. This document is a synthesis of hundreds of pages of reporting received by the NSW Health Department from Area Health Services (AHSs) and provides details of the cumulative progress made to date during the period from program commencement through to the end of September 2002. Most programs received initial funding in January 2001 and achievements since have been impressive. These are showcased in this report.
5. UK National Conferences Source of Information
Chronic Disease Management, Tuesday 18 May 2004 – The Brewery, London
Most recent DoH sponsored conference. Latest thinking. Includes major speakers from around the world:
Rafael Bengoa, Managing Chronic Conditions: An International Perspective
Growing evidence from around the world suggests that when patients with chronic conditions receive effective treatment within an integrated system, with self-management support and regular follow-up, they do better. Evidence also suggests that organised systems of care, not just individual health care workers, are essential in producing positive outcomes. The World Health Organisation has joined with the MacColl Institute for Healthcare Innovation to adapt the CCM from a global perspective. The resultant model, the Innovative Care for Chronic Conditions (ICCC) Framework, depicts the complementary nature of working across the disease continuum in a comprehensive way, and emphasises community and policy aspects of improving care.
Gerard Anderson, Chronic Care In America
The cost and prevalence of chronic conditions in the US. The problems encountered when people with chronic conditions receive care in a system oriented around acute care. Recent policy and clinical initiatives in the U.S. to reform the healthcare system around chronic care. Additional items for the U.S. and UK to consider.
Sue Roberts, Chronic Disease Management and the UK - Looking to the Future
Sue Roberts, National Diabetes Czar, will explore a systematic approach to chronic disease management based on her work with Diabetes and implementing the National Service Framework, learning from UK, Europe and USA, and Ed Wagner's Chronic Care Model
Harry Cayton, Disease Management or Life Management?
People with chronic diseases can successfully manage their condition and enable themselves to enjoy as full a life as possible. Harry Cayton will describe how the right information, support to enable patients to make choices, and working in partnership with health professionals can make a real difference for people with chronic conditions.
Alistair Howie, Evercare Programme: Chronic Disease Management and Redesign of Primary and Community Services
By focusing on small numbers of elderly, vulnerable patients in primary care, employing the Fusion IT project and the NHS adapted Evercare model of case management, the health community has reduced unplanned admissions and hospital lengths of stay, increased the functional status of patients and impacted on their pharmacy budget.
Reforming Health Systems: Applying the lessons from Managed Care in Hampshire and the Isle of Wight - a one-day development event on 9 March 2004
On Tuesday 9 March 2004 nearly 130 NHS and social professionals, private sector colleagues and lay people came together at the Hampshire Rose Bowl near Southampton to consider Managed Care models (such as Kaiser Permanente and EverCare) and how lessons from these models could usefully be applied to benefit patients and communities across Hampshire and the Isle of Wight.
This page is effectively the "Conference Report" from that event. It includes the Conference Pack, copies of presentation slides and write-ups from workshops and locality planning sessions (including the key messages from the day).
6. General
Improving primary care for patients with chronic illness. Thomas Bodenheimer, Edward H Wagner, Kevin Grumbach. JAMA. Chicago: Oct 9, 2002. Vol. 288, Iss. 14; p. 1775 (5 pages)
The chronic care model is a guide to higher-quality chronic illness management within primary care. The model predicts that improvement in its 6 interrelated components-self-management support, clinical information systems, delivery system redesign, decision support, health care organization, and community resources-can produce system reform in which informed, activated patients interact with prepared, proactive practice teams. Case studies are provided describing how components of the chronic care model have been implemented in the primary care practices of 4 health care organizations.
Improving primary care for patients with chronic illness: The chronic care model, part 2. Thomas Bodenheimer, Edward H Wagner, Kevin Grumbach. JAMA. Chicago: Oct 16, 2002. Vol. 288, Iss. 15; p. 1909 (6 pages)
This article reviews research evidence showing to what extent the chronic care model can improve the management of chronic conditions (using diabetes as an example) and reduce health care costs. Thirty-two of 39 studies found that interventions based on chronic care model components improved at least 1 process or outcome measure for diabetic patients. Regarding whether chronic care model interventions can reduce costs, 18 of 27 studies concerned with 3 examples of chronic conditions (congestive heart failure, asthma, and diabetes) demonstrated reduced health care costs or lower use of health care services. Even though the chronic care model has the potential to improve care and reduce costs, several obstacles hinder its widespread adoption.
Chronic illness management: What is the role of primary care? Arlyss Anderson Rothman, Edward H Wagner. Annals of Internal Medicine. Philadelphia: Feb 4, 2003. Vol. 138, Iss. 3; p. 256 (6 pages)
An estimated 99 million Americans live with a chronic illness. Meeting the needs of this population is one of the major challenges facing the U.S. health care system today and in the future. Dozens of studies, surveys, and audits have revealed that sizable proportions of chronically ill patients have not received effective therapy and do not have optimal disease control. The consistent findings of generally substandard care for many chronic conditions have spurred proposals that care be shifted to specialists or disease management programs. Published evidence to date does not indicate any clear superiority of these alternatives to primary care. The defining features of primary care (that is, continuity, coordination, and comprehensiveness) are well suited to care of chronic illness. A rapidly growing body of health services research points to the design of the care system, not the specialty of the physician, as the primary determinant of chronic care quality. The future of primary care in the United States may depend on its ability to successfully redesign care systems that can meet the needs of a growing population of chronically ill patients.
DoH (2004) Chronic disease management: a compendium of information.
Powerpoint presentation version
Who should read this compendium? In this compendium we have brought together much of the evidence about chronic disease from the UK and around the world. We hope it will support people who provide care for those who suffer from chronic diseases, and inform those that commission and manage the services that provide care for people with chronic diseases. In particular, we think there are important messages for the read this compendium. Further, those who provide care (general practices, community care, hospitals and social care) can all learn how to build on their strengths.
The evidence we have brought together shows that:-
Chronic disease is an important health issue, and is growing in importance
Your social circumstances affect the chance of you having a chronic disease greatly
Some patients have multiple chronic diseases, which make their care particularly complex
A small number of patients and diseases account for a disproportionate amount of health care use (especially hospital care)
There is evidence that chronic disease can be better managed through
Increased support for self care
Strengthening usual primary care
Offering responsive specialist care
Managing vulnerable cases by anticipating their needs
This approach is enshrined in the Chronic Care Model, the adoption of which has clear implications for the NHS
The benefits from chronic disease are two fold; better outcomes for patients and benefits for the NHS.
Cheshire and Merseyside Strategic Health Authority COPD Toolkit for Primary and Community Care
A guide to redesign and service improvement based on examples from Cheshire and Merseyside. Compiled by Anthony Hassall (01925 406000).
Improving chronic illness care: Translating evidence into action. Edward H Wagner, Brian T Austin, Connie Davis, Mike Hindmarsh, et al. Health Affairs. Chevy Chase: Nov/Dec 2001. Vol. 20, Iss. 6; p. 64 (15 pages)
The growing number of persons suffering from major chronic illnesses face many obstacles in coping with their condition, not least of which is medical care that often does not meet their needs for effective clinical management, psychological support, and information. The primary reason for this may be the mismatch between their needs and care delivery systems largely designed for acute illness. Evidence of effective system changes that improve chronic care is mounting. We have tried to summarize this evidence in the Chronic Care Model (CCM) to guide quality improvement. In this paper we describe the CCM, its use in intensive quality improvement activities with more than 100 health care organizations, and insights gained in the process.
Hospital bed utilisation in the NHS, Kaiser Permanente, and the US Medicare programme: analysis of routine data. Ham C, York N, Sutch S, Shaw R. BMJ [Clinical Research Ed.] [NLM - MEDLINE]. Nov 29 2003. Vol. 327, Iss. 7426; p. 1257
Full Text BMJ Website Link (Including Links To Responses And Letters To This Article)
Reforming Health Systems: Learning from Managed Care Models. Presentation by Chris Ham, Director, Department of Health Strategy Unit. Compares Kaiser Permanente to NHS. Based on BMJ article above:
Objective To compare the utilisation of hospital beds in the NHS in England, Kaiser Permanente in California, and the Medicare programme in the United States and California. Design Analysis of routinely available data from 2000 and 2001 on inpatient admissions, lengths of stay, and bed days in populations aged over 65 for 11 leading causes of use of acute beds.
Setting Comparison of NHS data with data from Kaiser Permanente in California and the Medicare programme in California and the United States; interviews with Kaiser Permanente staff and visits to Kaiser facilities. Results Bed day use in the NHS for the 11 leading causes is three and a half times that of Kaiser’s standardised rate, almost twice that of the Medicare California’s standardised rate, and more than 50% higher than the standardised rate in Medicare in the United States. Kaiser achieves these results through a combination of low admission rates and relatively short stays. The lower use of bed days in Medicare in California compared with Medicare in the United States suggests there is a “California effect” as well as a “Kaiser effect” in hospital utilisation.
Conclusion The NHS can learn from Kaiser’s integrated approach, the focus on chronic diseases and their effective management, the emphasis placed on self care, the role of intermediate care, and the leadership provided by doctors in Throughout the paper we use the term Kaiser as shorthand for the Kaiser Permanente Medical Care Programme. The programme is made up of the Kaiser Foundation Health Plan, Kaiser Foundation Hospitals, and the Permanente Medical Groups. There are more than 10 000 Permanente physicians in the medical groups and they serve more than 8 million Kaiser Permanente members. Kaiser is one of the oldest established health plans in the United States; it uses a range of managed care techniques (see below) to ensure that resources are used efficiently.
Getting more for their dollar: a comparison of the NHS with California's Kaiser Permanente. Feachem RG, Sekhri NK, White KL. BMJ [Clinical Research Ed.] [NLM - MEDLINE]. Jan 19 2002. Vol. 324, Iss. 7330; p. 135
Objective To compare the costs and performance of the NHS with those of an integrated system for financing and delivery health services (Kaiser Permanente) in California.
Methods The adjusted costs of the two systems and their performance were compared with respect to inputs, use, access to services, responsiveness, and limited quality indicators.
Results The per capita costs of the two systems, adjusted for differences in benefits, special activities, population characteristics, and the cost environment, were similar to within 10%. Some aspects of performance differed. In particular, Kaiser members experience more comprehensive and convenient primary care services and much more rapid access to specialist services and hospital admissions. Age adjusted rates of use of acute hospital services in Kaiser were one third of those in the NHS.
Conclusions The widely held beliefs that the NHS is efficient and that poor performance in certain areas is largely explained by under investment are not supported by this analysis. Kaiser achieved better performance at roughly the same cost as the NHS because of integration throughout the system, efficient management of hospital use, the benefits of competition, and greater investment in information technology.
National Primary and Care Trust Development Programme
Learning from Kaiser Permanente - A Briefing for PEC Members
The basics on Kaiser Permanente put together following BMJ articles.
2. Evercare
Implementing the Evercare Programme - Interim Report (Feb 2004)
Report by Evercare on the implement the Evercare model of care management at 9 NHS PCTs.
In autumn 2002, the Department of Health in England invited Ovation’s Evercare programme to contribute its tools, techniques, and expertise to help Primary Care Trusts (PCTs) enhance the speed and certainty of achieving the NHS Plan. An eight-week assessment in 10 PCTs was completed in February 2003. Following this, nine PCTs elected to implement the Evercare model of care management to improve the health of frail older people whilst reducing their need for hospitalisations.
This interim report provides a midterm review of the 17-month implementation phase of the Evercare project. The implementation phase began in April 2003 and runs through August 2004.
Evaluation of the Evercare Demonstration Program Final Report. Robert L. Kane, MD, Principal Investigator; Gail Keckhafer, Coordinator; John Robst, Federal Project Officer: Division of Health Service Research and Policy, School of Public Health, University of Minnesota.
Evercare represents a new approach to providing medical services to long-stay nursing home patients. It offers a capitated package of Medicare-covered services with more intensive primary care provided by nurse practitioners (NPs) to supplement, not supplant, the medical care provided by physicians. The program’s underlying premise holds that better primary care will result in reduced hospital use. At the same time, Evercare strives to optimize the health and wellbeing of the nursing home resident by providing complete, customized care planning, care coordination, and care delivery for frail and chronically ill elderly people living in nursing homes.
Conclusion. The Evercare program meets its objectives of reducing hospital admissions while providing quality and coordinated care to the nursing home resident. While the number of hospitalizations were reduced, indications of quality and patient satisfaction showed Evercare enrollees to receive care at least equal to that received by the control in both Evercare homes and homes not affiliated with Evercare. As the Evercare program continues to mature, it offers promise for continued reduction in unnecessary hospitalization. The use of Intensive Service Days provides an opportunity for residents to be treated in the nursing home without the disruption of travel to a hospital for a large segment of illness events.
The Effect of Evercare on Hospital Use. Kane RL, Keckhafer G, Bershadsky B, Siadaty MS. Journal of the American Geriatrics Society Volume 51, Issue 10, Page 1427-1434, Oct 2003
OBJECTIVES To examine the use of hospital and related medical care services of a novel managed care program using nurse practitioners (NPs) and directed specifically at long-stay nursing home residents. DESIGN Quasi-experimental post-test design with two control groups to minimize selection bias. SETTING Nursing homes. PARTICIPANTS Evercare enrollees in five sites were compared with two sets of controls: nursing home residents in the same nursing homes who did not enroll in Evercare (control-in) and residents of nursing homes that did not participate in Evercare (control-out). MEASUREMENTS Utilization data from Medicare and United Healthcare (the parent corporation for Evercare) were obtained for slightly more than 2 years. Patterns of use were assessed by calculating the monthly use rate for each group and aggregating to form annual rates. Usages addressed included hospital admissions and days, emergency room visits, therapy services, mental health services, and podiatry. Adjustments were made to correct for age, race, and sex. Because the groups differed in terms of the rate of cognitive impairment, the analysis was stratified on this variable. RESULTS The incidence of hospitalizations was twice as high in control residents as in Evercare residents (4.63 and 4.67 per 100 enrollees per month vs 2.43 in the 15 months after census, P<.001). This difference corresponded to Evercare's use of intensive service days. The same pattern held for preventable hospitalizations (0.80 and 0.86 vs 0.28, P<.001). The pattern held when residents were stratified by cognitive status. On average, using a NP is estimated to save about $103,000 a year in hospital costs per NP. CONCLUSION The use of active primary care provided by NPs may have prevented the occurrence of some hospitalizable events, but its major effect was allowing cases to be managed more cost-effectively.
3. Veterans
Effect of the transformation of the veterans affairs health care system on the quality of care. Ashish K Jha, Jonathan B Perlin, Kenneth W Kizer, R Adams Dudley. The New England Journal of Medicine. Boston: May 29, 2003. Vol. 348, Iss. 22; p. 2218 (10 pages)
BACKGROUND: In the mid-1990s, the Department of Veterans Affairs (VA) health care system initiated a systemwide reengineering to, among other things, improve its quality of care. We sought to determine the subsequent change in the quality of health care and to compare the quality with that of the Medicare fee-for-service program. METHODS: Using data from an ongoing performance-evaluation program in the VA, we evaluated the quality of preventive, acute, and chronic care. We assessed the change in quality-of-care indicators from 1994 (before reengineering) through 2000 and compared the quality of care with that afforded by the Medicare fee-for-service system, using the same indicators of quality. RESULTS: In fiscal year 2000, throughout the VA system, the percentage of patients receiving appropriate care was 90 percent or greater for 9 of 17 quality-of-care indicators and exceeded 70 percent for 13 of 17 indicators. There were statistically significant improvements in quality from 1994-1995 through 2000 for all nine indicators that were collected in all years. As compared with the Medicare fee-for-service program, the VA performed significantly better on all 11 similar quality indicators for the period from 1997 through 1999. In 2000, the VA outperformed Medicare on 12 of 13 indicators. CONCLUSIONS: The quality of care in the VA health care system substantially improved after the implementation of a systemwide reengineering and, during the period from 1997 through 2000, was significantly better than that in the Medicare fee-for-service program. These data suggest that the quality-improvement initiatives adopted by the VA in the mid-1990s were effective.
4. New South Wales
NSW Chronic and Complex Care Programs: Progress Report For Program activity to 30 September 2002
The NSW Government Action Plan for Health Chronic and Complex Care Priority Health Care programs are now in their second year of operation. This document is a synthesis of hundreds of pages of reporting received by the NSW Health Department from Area Health Services (AHSs) and provides details of the cumulative progress made to date during the period from program commencement through to the end of September 2002. Most programs received initial funding in January 2001 and achievements since have been impressive. These are showcased in this report.
5. UK National Conferences Source of Information
Chronic Disease Management, Tuesday 18 May 2004 – The Brewery, London
Most recent DoH sponsored conference. Latest thinking. Includes major speakers from around the world:
Rafael Bengoa, Managing Chronic Conditions: An International Perspective
Growing evidence from around the world suggests that when patients with chronic conditions receive effective treatment within an integrated system, with self-management support and regular follow-up, they do better. Evidence also suggests that organised systems of care, not just individual health care workers, are essential in producing positive outcomes. The World Health Organisation has joined with the MacColl Institute for Healthcare Innovation to adapt the CCM from a global perspective. The resultant model, the Innovative Care for Chronic Conditions (ICCC) Framework, depicts the complementary nature of working across the disease continuum in a comprehensive way, and emphasises community and policy aspects of improving care.
Gerard Anderson, Chronic Care In America
The cost and prevalence of chronic conditions in the US. The problems encountered when people with chronic conditions receive care in a system oriented around acute care. Recent policy and clinical initiatives in the U.S. to reform the healthcare system around chronic care. Additional items for the U.S. and UK to consider.
Sue Roberts, Chronic Disease Management and the UK - Looking to the Future
Sue Roberts, National Diabetes Czar, will explore a systematic approach to chronic disease management based on her work with Diabetes and implementing the National Service Framework, learning from UK, Europe and USA, and Ed Wagner's Chronic Care Model
Harry Cayton, Disease Management or Life Management?
People with chronic diseases can successfully manage their condition and enable themselves to enjoy as full a life as possible. Harry Cayton will describe how the right information, support to enable patients to make choices, and working in partnership with health professionals can make a real difference for people with chronic conditions.
Alistair Howie, Evercare Programme: Chronic Disease Management and Redesign of Primary and Community Services
By focusing on small numbers of elderly, vulnerable patients in primary care, employing the Fusion IT project and the NHS adapted Evercare model of case management, the health community has reduced unplanned admissions and hospital lengths of stay, increased the functional status of patients and impacted on their pharmacy budget.
Reforming Health Systems: Applying the lessons from Managed Care in Hampshire and the Isle of Wight - a one-day development event on 9 March 2004
On Tuesday 9 March 2004 nearly 130 NHS and social professionals, private sector colleagues and lay people came together at the Hampshire Rose Bowl near Southampton to consider Managed Care models (such as Kaiser Permanente and EverCare) and how lessons from these models could usefully be applied to benefit patients and communities across Hampshire and the Isle of Wight.
This page is effectively the "Conference Report" from that event. It includes the Conference Pack, copies of presentation slides and write-ups from workshops and locality planning sessions (including the key messages from the day).
6. General
Improving primary care for patients with chronic illness. Thomas Bodenheimer, Edward H Wagner, Kevin Grumbach. JAMA. Chicago: Oct 9, 2002. Vol. 288, Iss. 14; p. 1775 (5 pages)
The chronic care model is a guide to higher-quality chronic illness management within primary care. The model predicts that improvement in its 6 interrelated components-self-management support, clinical information systems, delivery system redesign, decision support, health care organization, and community resources-can produce system reform in which informed, activated patients interact with prepared, proactive practice teams. Case studies are provided describing how components of the chronic care model have been implemented in the primary care practices of 4 health care organizations.
Improving primary care for patients with chronic illness: The chronic care model, part 2. Thomas Bodenheimer, Edward H Wagner, Kevin Grumbach. JAMA. Chicago: Oct 16, 2002. Vol. 288, Iss. 15; p. 1909 (6 pages)
This article reviews research evidence showing to what extent the chronic care model can improve the management of chronic conditions (using diabetes as an example) and reduce health care costs. Thirty-two of 39 studies found that interventions based on chronic care model components improved at least 1 process or outcome measure for diabetic patients. Regarding whether chronic care model interventions can reduce costs, 18 of 27 studies concerned with 3 examples of chronic conditions (congestive heart failure, asthma, and diabetes) demonstrated reduced health care costs or lower use of health care services. Even though the chronic care model has the potential to improve care and reduce costs, several obstacles hinder its widespread adoption.
Chronic illness management: What is the role of primary care? Arlyss Anderson Rothman, Edward H Wagner. Annals of Internal Medicine. Philadelphia: Feb 4, 2003. Vol. 138, Iss. 3; p. 256 (6 pages)
An estimated 99 million Americans live with a chronic illness. Meeting the needs of this population is one of the major challenges facing the U.S. health care system today and in the future. Dozens of studies, surveys, and audits have revealed that sizable proportions of chronically ill patients have not received effective therapy and do not have optimal disease control. The consistent findings of generally substandard care for many chronic conditions have spurred proposals that care be shifted to specialists or disease management programs. Published evidence to date does not indicate any clear superiority of these alternatives to primary care. The defining features of primary care (that is, continuity, coordination, and comprehensiveness) are well suited to care of chronic illness. A rapidly growing body of health services research points to the design of the care system, not the specialty of the physician, as the primary determinant of chronic care quality. The future of primary care in the United States may depend on its ability to successfully redesign care systems that can meet the needs of a growing population of chronically ill patients.
DoH (2004) Chronic disease management: a compendium of information.
Powerpoint presentation version
Who should read this compendium? In this compendium we have brought together much of the evidence about chronic disease from the UK and around the world. We hope it will support people who provide care for those who suffer from chronic diseases, and inform those that commission and manage the services that provide care for people with chronic diseases. In particular, we think there are important messages for the read this compendium. Further, those who provide care (general practices, community care, hospitals and social care) can all learn how to build on their strengths.
The evidence we have brought together shows that:-
Cheshire and Merseyside Strategic Health Authority COPD Toolkit for Primary and Community Care
A guide to redesign and service improvement based on examples from Cheshire and Merseyside. Compiled by Anthony Hassall (01925 406000).
Improving chronic illness care: Translating evidence into action. Edward H Wagner, Brian T Austin, Connie Davis, Mike Hindmarsh, et al. Health Affairs. Chevy Chase: Nov/Dec 2001. Vol. 20, Iss. 6; p. 64 (15 pages)
The growing number of persons suffering from major chronic illnesses face many obstacles in coping with their condition, not least of which is medical care that often does not meet their needs for effective clinical management, psychological support, and information. The primary reason for this may be the mismatch between their needs and care delivery systems largely designed for acute illness. Evidence of effective system changes that improve chronic care is mounting. We have tried to summarize this evidence in the Chronic Care Model (CCM) to guide quality improvement. In this paper we describe the CCM, its use in intensive quality improvement activities with more than 100 health care organizations, and insights gained in the process.
